Thursday, March 14, 2013

OBESITY & WEIGHT MANAGEMENT


 
by Saritha Uppala, MD

 
Obesity has reached epidemic proportions in the United States.  In Alabama, among residents age 18 and older, 69 percent are overweight with a Body Mass Index (BMI) of 25 or greater ; 32.2 percent are obese, with a BMI of 30 or greater.  This puts Alabama in fourth place for the state with the highest obesity rates. By 2030, 62.6 percent of adult Alabamians will be obese, nearly double the 32 percent in 2011.

 
Many of us think obesity and overweight are simply due to an energy imbalance; therefore it seems logical to advise “just push yourself away from the table and join a gym.” However, many other factors should be considered– food, environment, socioeconomic status, family structure variation, community dynamics, health care, genetic influence and metabolic problems. Fast foods have been a large contributor and supersizing makes the situation worse. For example, drinking one soda a day for a year (150 calories) will add 15 extra pounds. Just to burn the calories in a single, plain pack of M&M candy, one has to walk the entire length of a football field (100 yards).

 
Obesity related disease starts early – BMI 24(women), 28 (men). It has been estimated that over 300,000 deaths per year in America are attributable to obesity, making it the second most frequent preventable cause of death (after tobacco smoking).

 
Obesity is linked to cardiovascular disease (coronary heart disease, hypertension, myocardial infarction, congestive heart failure, and stroke), diabetes, and various types of cancer, as well as many other health problems. An increase in BMI from <25 to >30kg/m2 is associated with an increased prevalence of hypertension from 15 percent to 40 percent. For one unit increase in BMI increases the prevalence of congestive heart failure by 5 percent, gallstones by 5-11 percent, hemorrhagic stroke by 6 percent. Weight loss in obese patients associated with decrease in 4 mm Hg systolic and 2 mm Hg diastolic per Kg of weight reduction, similar benefits noted in osteoarthritis, obstructive sleep apnea, diabetes, and may improve depression in many individuals.

 
Obesity is a medical condition with numerous co-morbidities and deserves to be approached as a serious health threat. Overweight patients deserve competent, nonjudgmental, ompassionate, and comprehensive treatment by medical personnel willing to take the time and have the patience to see them through a long –term treatment regimen, particularly in those whose weight is creating major social or emotional challenges.

       
There are many diet options that work but the right one to use will depend on the individual patient. Each obese patient is different and Heterogeneity exists among those who are overweight and obese. A traditional, low-fat diet may be particularly ineffective for weight loss for those with insulin resistance, which explains the substantial variability in weight loss success among different individuals trying to follow the same diet. We strongly believe that treatment plan should be individualized.

 
With that in mind, the physicians of Medicine Montclair are now offering a weight loss program entitled “Aim for Healthy Weight.”  This program is completely focused on an individualized treatment plan that assesses the readiness of the patient to lose weight, evaluates the patient to better understand their current lifestyle, analyzes the cause of excess weight, and investigates specific abnormalities in lab tests that can identify co-morbidities associated with obesity.

“Aim for Healthy Weight” allows the physician to work closely with the patient to set realistic goals for weight loss, maintenance of weight loss and prevention of weight gain. 

 
While we can’t promise miracles, we can strive to better understand the problem and issues facing the patient and establish a sensible approach that will have a better than even chance at success.

 

 
Dr. Saritha Uppala

Medicine Montclair – Trinity Medical Center

Fellow, American Society of Bariatric Physicians,

Board certified in American Board of Obesity Medicine

Board certified in Internal Medicine

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